Dental appliance binding structure

ABSTRACT

The present disclosure provides methods, computing device readable medium, devices, and systems having a dental appliance binding structure. One method can include to create a treatment plan based on a virtual model of a jaw of a patient, wherein the treatment plan includes use of a dental appliance having a first surface that defines a plurality of cavities shaped to receive a plurality of teeth, modify the virtual model of the jaw in a first configuration to include a virtual binding structure on a second surface, the platform shaped to receive a specialized feature that provides one or more force characteristics, select a particular specialized feature as an attachment to the dental appliance, and adjust the virtual model of the jaw from a first configuration to a second configuration, based at least in part on a modeled force provided by the virtual binding structure and the particular specialized feature.

BACKGROUND

The present disclosure provides methods, computing device readablemedium, devices, and systems that utilize a dental appliance bindingstructure during dental treatment. Dental treatments involve restorativeand/or orthodontic procedures to improve the quality of life of apatient.

For example, restorative procedures may be designed to implant a dentalprosthesis (e.g., a crown, bridge, inlay, onlay, veneer, etc.)intraorally in a patient. Orthodontic procedures may includerepositioning misaligned teeth and changing bite configurations forimproved cosmetic appearance and/or dental function. Orthodonticrepositioning can be accomplished, for example, by applying controlledforces to one or more teeth or a jaw of a patient over a period of time.

As an example, orthodontic repositioning may be provided through adental process that uses positioning appliances for realigning teeth.Such appliances may utilize a shell of material having resilientproperties, referred to as an “aligner,” that generally conforms to apatient's teeth but is slightly out of alignment with a current toothconfiguration.

Placement of such an appliance over the teeth may provide controlledforces in specific locations to gradually move the teeth into a newconfiguration. Repetition of this process with successive appliances inprogressive configurations can move the teeth through a series ofintermediate arrangements to a final desired arrangement (e.g., acorrected jaw position).

Such systems typically utilize a set of appliances that can be usedserially such that, as the teeth move, a new appliance from the set canbe implemented to further move the teeth without having to take a newimpression of the patient's teeth at every increment of tooth movementin order to make each successive appliance.

In various instances, teeth of a patient's upper jaw and teeth of thepatient's lower jaw may contact in an incorrect or suboptimal manner(e.g., crowding, crossbite, deep bite). A proper fit of the occlusalsurfaces of the teeth is necessary for proper biting and chewing, aswell as desirable for aesthetic appearance. Otherwise, premature wear ofthe teeth, undesirable forces on the teeth, and/or undesirable forces ondental restorations may be experienced by the patient.

Appliances have been previously proposed to handle these issues but thedesign of the appliances to handle some issues cannot be created withthe manufacturing processes being utilized presently or theirmanufacture is too complicated to be feasible using currentmanufacturing techniques.

With respect to jaw repositioning, previously proposed devices typicallyhave not allowed for teeth to be repositioned while the jaw adjustmentis ongoing. Further, such appliances are typically not comfortable oraesthetically pleasing.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates an angled side view of a shell with two bindingstructures thereon with each structure having a specialized featureattached thereto according to a number of embodiments of the presentdisclosure.

FIG. 2 illustrates a top view of a first shell with a binding structurethereon having a specialized feature attached thereto according to anumber of embodiments of the present disclosure.

FIG. 3 illustrates an elevated side view of a shell with two bindingstructures thereon with each binding structure having a specializedfeature attached thereto according to a number of embodiments of thepresent disclosure.

FIG. 4 illustrates a side view of an upper jaw having a first shell witha specialized feature attached to a binding structure thereon and alower jaw having a second shell with a second specialized featureattached to a binding structure according to a number of embodiments ofthe present disclosure.

FIG. 5 illustrates an angled side view of a model for fabricating ashell with two binding structures thereon according to a number ofembodiments of the present disclosure.

FIG. 6 illustrates a computing device that can be utilized according toone or more embodiments of the present disclosure.

FIG. 7 illustrates a method according to one or more embodiments of thepresent disclosure.

FIG. 8 illustrates a method according to one or more embodiments of thepresent disclosure.

DETAILED DESCRIPTION

The present disclosure provides methods, computing device readablemedium, devices, and systems having a dental appliance bindingstructure. A device having such binding structures can be beneficial asit can allow the appliance to provide multiple functions in thetreatment of a patient's issues and can shorten the time of treatment byconcurrently providing multiple functions, in some instances.

FIG. 1 illustrates an angled side view of a shell with two bindingstructures thereon with each structure having a specialized featureattached thereto according to a number of embodiments of the presentdisclosure. FIG. 1 provides an example of an embodiment of a dentalappliance 100 that has a shell 102 with a number of cavities forreceiving teeth, a number of binding structures 104, and a number ofspecialized features 106 attached to the shell on at least one surfaceof the binding structure 104.

In the present disclosure, reference is made to the accompanyingdrawings that form a part hereof, and in which is shown by way ofillustration how one or more embodiments of the disclosure may bepracticed. These embodiments are described in sufficient detail toenable those of ordinary skill in the art to practice the embodiments ofthis disclosure, and it is to be understood that other embodiments maybe utilized and that process, electrical, and/or structural changes maybe made without departing from the scope of the present disclosure.

As used herein, the designator “N”, particularly with respect toreference numerals in the drawings, indicates that a number of theparticular feature so designated can be included. As used herein, “anumber of” a particular thing can refer to one or more of such things(e.g., a number of teeth can refer to one or more teeth).

The figures herein follow a numbering convention in which the firstdigit or digits correspond to the drawing figure number and theremaining digits identify an element or component in the drawing.Similar elements or components between different figures may beidentified by the use of similar digits. For example, 106 may referenceelement “06” in FIG. 1, and a similar element may be referenced as 206in FIG. 2.

As will be appreciated, elements shown in the various embodiments hereincan be added, exchanged, and/or eliminated so as to provide a number ofadditional embodiments of the present disclosure. In addition, as willbe appreciated, the proportion and the relative scale of the elementsprovided in the figures are intended to illustrate certain embodimentsof the present disclosure, and should not be taken in a limiting sense.

In the example shown in FIG. 1, the binding structure includes a firstbinding surface (in this instance, a first attachment surface in theform of a planar platform on the outer occlusal surface of theappliance) and a second binding surface (a second attachment surface inthe form of a planar side surface on the outer buccal surface of theappliance). In this manner, the specialized feature can be attached toone or more binding surfaces of the appliance. Attachment to multiplesurfaces can be beneficial in some embodiments, for example, to increasethe amount of force that can be applied by the feature and/or provideforces in multiple directions, among other benefits.

The method of attachment can be rigid or flexible, in some embodiments,and can have rigid and flexible portions along one binding surface, invarious embodiments. For example, the attachment can be made via a rigidtype adhesive in which the interposing attachment material between thebinding surface and the specialized feature is rigid and therebyprohibits the movement of the specialized feature with respect to thebinding surface.

Alternatively, a flexible type adhesive can be utilized in which theinterposing attachment material between the binding surface and thespecialized feature is flexible and thereby allows some movement of thespecialized feature with respect to the binding surface. This can bebeneficial in instances where some give or cushion is desirable.

When used in combination on different portions of the same surface, onebenefit can be the application of forces by the specialized featureand/or shell in different degrees and in different directions than whenone type of attachment material is utilized. This can allow for furthercustomization of a treatment plan of a patient and/or additional usesfor such specialized features, among other benefits.

As will be discussed in more detail below, in some embodiments, theattachment can be a mechanical form of attachment (e.g., lock and keytype attachment, male and female locking attachment, etc.). Any suitableattachment structure can be utilized in embodiments of the presentdisclosure.

Additionally, in some embodiments, the attachment can be releasable,thereby allowing the specialized feature to be removable and, in someembodiments, replaceable with a same or different specialized feature.This can allow a patient or treatment professional to temporarily removethe specialized feature which allows the patient and the treatmentprofessional flexibility in when the additional treatment thespecialized feature provides is implemented.

Further, different types of specialized features can be utilized toprovide different abilities to the appliance. Some embodiments caninclude multiple types of features on a single appliance and potentiallymultiple features on one binding surface, in some embodiments.

In various embodiments, a set of specialized features can be madeavailable to a treatment professional. For example, a set of fivespecialized features can be provided and the treatment professional canselect from those five features. In this manner, the treatmentprofessional does not need to design their own feature, but rather canselect the feature that will be most appropriate for the patient'sissue.

This can allow the appliance to be specialized to the patient, but notbe onerous on the treatment profession who, for example, may not havefeature design capabilities. Such embodiments can also allow a treatmentprofessional to see what types of conditions the appliance canpotentially remedy based on the available specialized features providedin the set of features.

In some embodiments, the treatment professional may also select one ormore attachment materials or attachment types and/or select the locationupon which they should be applied. Such embodiments, can allow furthercustomization of the appliance. Further, in various embodiments, thiscustomization can be made for each appliance (or for multipleappliances) in a set of appliances of a treatment plan.

The following discussion relates to an example use for embodiments ofthe present disclosure related to use of one or more jaw repositioningelements as the attached specialized features to help the readerunderstand how an embodiment of the present disclosure may be utilized.However, the present disclosure should not be viewed as being limited tosuch specialized features. As the reader will understand, any suitablespecialized feature that may resolve an issue in the patient's mouth canbe mounted to a binding structure as described herein.

Generally, the repositioning of teeth occurs during an orthodontictreatment which is a process of moving and reorienting teeth forfunctional and/or aesthetic purposes, although repositioning may be madefor other purposes. The repositioning of a jaw typically requiresdifferent mechanisms to do so than are used for tooth repositioning and,therefore, typically occurs at a different time during a treatment plan,thereby extending the treatment process.

Various embodiments of the present disclosure can accomplish both toothadjustment and jaw adjustment at the same time through use of an alignerwith one or more specialized features provided on one or more bindingstructures thereon. The appliance thereby has both capabilities and canshorten the time of treatment thereby improving the treatment processfor the patient.

With respect to jaw movement, the maxilla (i.e., the upper jaw) is abone that is fixed to the skull and the mandible (i.e., lower jaw) is abone that is attached to the skull by numerous muscles which guide itsmovement and it is the interaction of these bones and muscles thatprovide a proper bite orientation for a patient. For instance, properbite orientation can be a function of the relative positions of one ormore teeth, the mandible, and/or the maxilla. For example, either of themandible or maxilla may be retruded or protruded relative to an idealposition with respect to each other.

The mandible functions by articulating at its posterior upwardextremities with the temporal bone to form the jaw joint. The jaw jointis a loosely connected joint that accommodates the variety of movementsof the mandible relative to the maxilla during biting and chewingmotions. The numerous muscles attaching the mandible to the skullcontrol and power the complex movements involved in biting and chewing.Accordingly, it can be beneficial to the patient to have a properlyaligned mandible.

Simultaneous contacting of the upper and lower teeth on the right andleft sides, and in the anterior and posterior occlusal areas withmaximum interdigitation can be desired for proper positioning of thelower jaw to the upper jaw in the mouth of a patient. An unbalancedocclusion, such as a malocclusion, can be disruptive to the properbiting and chewing functions because excessive forces may be placed in aparticular area that can lead to premature wear and/or restorationfailure, or because undesirable forces such as flexion may lead tostresses which can cause abfraction lesions and/or crowding/spacing ofthe teeth. Accordingly, the position of a patient's jaw can be changed,for instance, using an orthodontic appliance (e.g., a dental appliance)to reduce or avoid such issues.

Current approaches for jaw repositioning, such as those performed priorto fixed orthodontic treatment (i.e., “braces”) include having atreatment professional place an orthodontic appliance (which may includeblock elements, wires, tensioning springs, horizontal stops, etc.),which is firmly fixed to the teeth and which applies repositioningforces to move the jaw of the patient, thereby causing the relativepositioning of the patient's upper and lower jaws to adjust. Somebelieve that this repositioning stimulates jaw growth in patients withgrowth potential remaining, while others believe that the muscles canre-learn a new position so long as the teeth are made to fit togetherwell in the new jaw position.

As discussed above, current appliances for jaw repositioning are notdesigned to reposition the teeth during the process of jawrepositioning. As such, after adjustment of the position of thepatient's jaw, further orthodontic treatment is performed to move andre-orient the teeth of the patient for improved dental interdigitation,if necessary.

Many of the current jaw repositioning devices can be displeasing topatients, both physically and aesthetically, because the patient doesnot have the option to remove the appliance even for a short period oftime. Such appliances (e.g., a Herbst appliance) are typically cementedinto place on the patient's teeth.

One factor to be weighed in adjusting the position of the mandible isthe best fit or seating of the condyles of the mandible within the jointhousing of the temporal bone. The position that is the mostposterior-superior position of the condyle in the joint is usually anideal position representing full seating. Another factor is the best fitof the teeth between the maxilla and the mandible.

Ideally, the teeth fit together best in occlusion with the left andright jaw joints fully seated at the same time, but this is not arequirement. Sometimes, the teeth fit together best with the condylesslightly displaced from the joint. As a result, when the condyles arefully seated, the teeth may not be in their best fitting position, insuch instances. This condition is known as a shift between the centricrelationship (condyles fully seated) and the centric occlusion (teethbest fitting).

Because the condylar relationship affords some flexibility in thepositioning of the jaw, the lower jaw can be intentionally repositionedin accordance with the best fit of the teeth, for instance, by using anorthodontic appliance. The orthodontic appliances of the presentdisclosure that can be used may be more pleasing, both physically andaesthetically, to a patient undergoing treatment which intentionallyrepositions the lower jaw than appliances currently being utilized.

Depending on whether the jaw change is due to growth or muscularrepositioning, realigning the teeth of a patient after repositioning thejaw can result in reversion of the position of the jaw if the teeth arenot positioned and/or repositioned in a manner that best supports thenew jaw position. This could occur, for example, if the teeth fit betterin a jaw position different from the one which is accomplished throughthe jaw repositioning phase of the treatment.

In this situation, the jaw can revert toward its original position orwhatever position is most comfortable for the patient when biting sincethe jaw repositioning appliance has been removed. Therefore, the desireis to reposition the jaw to an optimal relation while at the same timearrange the teeth such that they fit together in the best possiblearrangement for the specific patient (as each patient's mouth hasdifferent characteristics and, therefore, each patient will have adifferent best outcome), both in arch coordination between the upper andlower arches and in interdigitation between the arches. Theinterdigitation makes the patient more likely to keep the lower jaw inthe new position since the teeth fit together the better in theinterdigitated position than in the non-interdigitated position.

Repositioning a jaw (e.g., separation of occlusal surfaces and/or movingthe position of a lower jaw forward, backward, or laterally) accordingto embodiments of the present disclosure can include utilizing a set ofone or more appliances, such as positioners, retainers, and/or otherremovable appliances (e.g., shells that don't reposition teeth and/oraligners) that are created, for example, by a treatment plan based on avirtual model of one or more jaws of a patient. In such embodiments, thetreatment plan can include the use of a dental appliance having a firstsurface (inner surface) that defines a plurality of cavities shaped toreceive a plurality of teeth, modify the virtual model of the jaw in afirst configuration to include a virtual binding structure on a secondsurface (outer surface), the structure shaped to receive a specializedfeature that provides one or more force characteristics, select aparticular specialized feature as an attachment to the dental appliance,and adjust the virtual model of the jaw from a first configuration to asecond configuration, based at least in part on a modeled force providedby the virtual binding structure and the particular specialized feature.In such a manner, each appliance can be modified to create a specializeddevice that can be used to correct specific features of issue for apatient.

For example, if an improperly positioned jaw is an issue, one or morerepositioning jaw elements can place a force on the lower jaw of thepatient to sagittally move the lower jaw. Movement of a jaw, as usedherein, can include revising a position of a lower jaw relative to theupper jaw (e.g., in a forward, backward, and/or lateral direction). Forinstance, the position of the patient's lower jaw can shift to stimulatejaw growth in patients with growth potential remaining and/or to allowmuscles to re-learn a new position. Such movement and other functions ofthe embodiments of the present disclosure are discussed in more detailbelow and some examples are shown in the accompanying drawings.

With respect to applications dealing with jaw repositioning, in variousembodiments, the movement of the jaw can be controlled to reposition thepatient's jaw in an anterior-posterior plane with respect to the jaws ofthe patient. For example, a first repositioning jaw element and a secondrepositioning jaw element can be positioned to interface as the patientmoves to a fully engaged jaw position of the patient's upper dentitionand the patient's lower dentition and wherein this movement is designedto reposition the patient's jaw in an anterior-posterior plane withrespect to the jaws of the patient.

A dental appliance, in accordance with some embodiments of the presentdisclosure, can include a first shell having a number of tooth aperturesconfigured to receive and reposition a number of teeth of a patient'supper dentition and/or a second shell having a number of tooth aperturesconfigured to receive and reposition a number of teeth of the patient'slower dentition. Each shell (e.g., the first shell and second shell) canhave one or more specialized features attached to a binding structure.

In some embodiments, the specialized features can be positioned on eachrespective shell to, for example, interact and/or interface at surfacesin the presence of a fully engaged jaw position of the patient's upperjaw and the patient's lower jaw in order to reposition the patient's jawand/or separate occlusal surfaces of the patient's teeth for treatmentpurposes. A fully engaged jaw position, as used herein, can include arelationship of the mandible and the maxilla when the upper and lowerjaw are closed as far as the dental appliance with the repositioning jawelements will allow (e.g., a partial occlusal jaw position).

For example, the separation of occlusal surfaces of the patient's teethcan be used to treat sagittal malocclusions (including crossbites), deepbites, open bites, and/or other malocclusions, in various embodiments.The specialized features selected and positioned on the shell can bepositioned such that the specialized features avoid interference withthe shells of the dental appliance that are used to align the teeth.

For instance, the separation of occlusal surfaces can include theocclusal surfaces of at least some of the teeth within the shells and/ora portion of occlusal surfaces of the shells interacting with one ormore surfaces of the specialized features of a shell on an opposing jaw.In this manner, a dental appliance in accordance with embodiments of thepresent disclosure can be used to concurrently treat sagittalmalocclusions, including crossbite and/or deep bite, whilesimultaneously repositioning a number of teeth of the patient. Further,in some embodiments, all of this tooth and jaw movement can be plannedvia computing device executable instructions (e.g., as described withrespect to FIG. 6) and therefore, excessive or redundant movementsbetween the two typically separate processes can be avoided, among otherbenefits.

Additionally, a virtual model can be created and tested so that thepatient does not have to be subjected to trial and error to achieveproper jaw and teeth positioning. The ability to visualize therepositioned jaws and establish the alignment in the repositionedconfiguration is advantageous because the best alignment of the teethwhen the jaw is repositioned can be precisely established and can bedifferent from the alignment when the jaws are not repositioned into animproved or optimal position.

In some embodiments, a plurality of appliances can be worn by a patientsuccessively, for example, to achieve gradual simultaneous and/orsequential repositioning of the patient's jaw and/or gradual toothmovement. For instance, each of a plurality of dental appliances canreposition the patient's jaw in incremental distances. In suchembodiments, the positions of the repositioning jaw elements can beadjusted to allow the treatment professional to fine tune the movementof the jaw symmetrically or asymmetrically and/or to move the teethincrementally which may be less painful than with fixed appliances whichmay impart more sudden force in the initial period of the process thanlater in the process, among other benefits.

FIG. 2 illustrates a top view of a first shell with a binding structurethereon having a repositioning jaw element attached thereto according toa number of embodiments of the present disclosure. FIG. 2 provides anexample of an embodiment of a dental appliance 200 that has a shell 202with a number of cavities for receiving teeth, a binding structure 204,having multiple attachment surfaces 205-1 and 205-N, and a specializedfeature 206 attached to the shell on at least one surface of thestructure 204.

As in the embodiment of FIG. 1, in the example shown in FIG. 2, thebinding structure 204 includes a first binding surface 205-1 (e.g., aplanar platform) on the outer occlusal surface of the appliance and asecond binding surface 205-N (e.g., a planar side surface) on the outerbuccal surface of the appliance. In this manner, the specialized featurecan be attached to one or more surfaces of the appliance (in theembodiment shown in FIG. 2, the specialized feature is attached to thefirst and second binding surfaces). As discussed above, attachment tomultiple surfaces of the appliance can be beneficial, for example, toincrease the amount of force that can be applied by the feature, provideforces in multiple directions, and other benefits.

Further, as discussed above, such attachment can be rigid, flexible, ora combination of rigid and flexible portions. For example, attachment tosurface 205-1 may be rigid and attachment to surface 205-N may beflexible or attachment to a front portion of surface 205-1 may be rigidwhile attachment to a back portion of surface 205-1 may be flexible, invarious embodiments, based on the type of attachment material used.

FIG. 3 illustrates an elevated side view of a shell with two bindingstructures thereon with each binding structure having a repositioningjaw element attached thereto according to a number of embodiments of thepresent disclosure. FIG. 3, shows a physical appliance 300 having ashell 302 positioned over a mold of the lower jaw of a patient's teeth308 based on a particular stage in a treatment plan. As discussedherein, this could be one stage of multiple stages represented inphysical form by a model.

In this embodiment, the binding surface 304 on the outer occlusalsurface of the appliance only extends across a portion of the occlusalsurface of the tooth 309. Such an embodiment may be beneficial in asituation in which the cavity surrounding the tooth 309 is used toprovide force against one or more surfaces of the tooth and, therefore,a shape more conforming to the shape on the tooth can be utilized, amongother benefits.

FIG. 4 illustrates a side view of an upper jaw having a first shell witha first repositioning jaw element attached to a binding structurethereon and a lower jaw having a second shell with a secondrepositioning jaw element attached to a binding structure according to anumber of embodiments of the present disclosure. Such a configurationmay be useful in repositioning a jaw of a patient.

For example, in some instances, the patient may exhibit abnormalocclusion or malocclusion. For instance, this may include a jaw (orboth) that is protrusive, retrusive, or laterally displaced. As anexample, positioning of the number of teeth of the patient's upperdentition and the number of teeth of the patient's lower dentition canbe such that the best fit of the upper dentition with the lowerdentition results in a misalignment of the lower jaw 410-1 relative tothe upper jaw 410-2 either in positional relation or at the level of thejaw joint which connects the lower jaw to the upper jaw.

The lower jaw can be in a retruded position, for instance, resulting ina distance (e.g., space) between the front teeth of the upper dentitionand the front teeth of the lower dentition (e.g., an increased overjet).Correction of the malocclusion can be beneficial to the patient in termsof improved chewing ability, reduced premature wear of the teeth, and/orimproved facial aesthetics.

Although the specialized features and jaws illustrated in FIG. 4 arephysical features and jaw models, similar virtual specialized featuresand virtual jaws of a patient can be presented on a computing device forpurposes of treatment planning and/or in fabrication of such physicalfeatures and/or jaw models, in some embodiments. Examples of suchvirtual items include two dimensional or three dimensional versions ofitems devised via a treatment plan, devised by a treatment professional,and/or based on actual, physical items. An example of a system forproviding such a virtual embodiment is described in more detail withrespect to FIG. 6.

In the embodiment of FIG. 4, a specialized feature 406-1, as usedherein, can extend beyond the occlusal plane of a shell 402-1 of aremovable dental appliance 410-1 to engage with buccal or lingualcoronal side surfaces of at least one tooth and/or a specialized feature406-2 of shell 402-2 of a removable dental appliance 410-2 on theopposite jaw of the patient. The specialized features can, for instance,add retention to molar teeth to balance movement created by therepositioning jaw elements and/or prevent and/or limit a posteriorsurface of the removable dental appliance from contacting molars, amongother functions. Through use of the specialized features shown in FIG.4, the jaws of the patient can be aligned, both in an anterior-posteriorrelationship and in a lateral relationship (mesial-distal relationship).

In some embodiments, a removable dental appliance can, for example,include a first shell having a number of tooth apertures configured toreceive a number of teeth of a patient's upper jaw, the first shellincluding a first binding structure positioned specific to the patientand having an attachment surface having a predetermined shape to matewith an attachment surface of a first specialized feature that can beattached to the first binding structure.

As discussed herein, the first and the second specialized features canbe attached using an attachment material or via a mechanical lockingmechanism having portions on both, the specialized feature and thebinding structure that interlock to hold the binding structure andspecialized feature together. For example, the appliance can include ashell having a number of tooth apertures configured to receive a numberof teeth of a patient's lower jaw, the shell including a bindingstructure positioned specific to the patient such that a specializedfeature can be attached to the binding structure, and wherein thebinding structure includes a protruding element to mechanically lockwith an intruding element of the specialized feature.

In some embodiments, one or more of the specialized features can beformed of a different material than a first shell, a second shell,and/or one or more of the binding structures. However, some embodimentscan have the first shell, the second shell, and/or one or more of thebinding structures formed of a same material (e.g., a polymericmaterial). Further, one or more of the specialized features can beformed of a same material as the first shell, the second shell, and oneor more of the binding structures. This allows for additionalcustomization of the appliance to the needs of the patient and mayprovide benefits in manufacturing the appliance.

The shapes and orientations of the binding structures can be varied aswell. For example, the first binding structure and/or the second bindingstructure can extend from an occlusal surface of the first shell and thesecond shell, in some embodiments. The first binding structure and thesecond binding structure can also include surfaces that can be angledand protrude away from an occlusal plane of the patient (e.g., asillustrated in the embodiment of FIG. 1).

Some embodiments provide a dental appliance system having a number ofcomponents. For example, one system includes a first dental applianceincluding a first shell having a number of tooth apertures configured toreceive a number of teeth of a patient according to a first stage of atreatment plan, the first shell including a first binding structurepositioned specific to a tooth arrangement of the patient associatedwith the first stage such that a first specialized feature can beattached to the first binding structure.

The system also includes a second dental appliance including a secondshell having a number of tooth apertures configured to receive a numberof teeth of the patient according to a second stage of the treatmentplan, the second shell including a second binding structure positionedspecific to a tooth arrangement of the patient associated with thesecond stage such that a second specialized feature can be attached tothe second binding structure. The first specialized feature can beattached to the first binding structure and the second specializedfeature can be attached to the second binding structure.

In some such embodiments, the first dental appliance is configured toreposition a jaw of the patient a first incremental distance accordingto the first stage of the treatment plan. The first dental appliance canalso be configured to reposition one or more teeth of the patient afirst incremental distance according to the first stage of the treatmentplan.

In various embodiments, the second dental appliance is configured toreposition the jaw of the patient a second incremental distanceaccording to the second stage of the treatment plan. In this manner, theteeth can be moved in increments which can allow for providing more orless force to different teeth or portions of a jaw at different timesduring treatment. The first and second dental appliances can be part ofa series of dental appliances and may not represent the first and secondin the series, but rather may have appliances before the first applianceand have appliances after the second appliance.

FIG. 5 illustrates an angled side view of a model for fabricating ashell with two binding structures thereon according to a number ofembodiments of the present disclosure. In the embodiment of FIG. 5, amold is illustrated which has a portion of a jaw of a patient 508including a number of physical tooth models 520.

The mold also includes multiple binding structures 512-1 and 512-2. Eachbinding structure also includes a non-planar binding surface 514-1 and514-2. In contrast to the planar binding surfaces of FIGS. 1-4, thesebinding surfaces include a portion that is non-planar and can provide anumber of benefits, in some applications.

For example, when used with a mating surface on a specialized feature,the non-planar binding surface can provide added surface area to aid inattachment of the specialized feature and the binding surface. Further,in some embodiments (e.g., where the binding structure and thespecialized feature are formed of different materials), the non-planarbinding surface can provide a different characteristic to thespecialized attachment.

For instance, the illustrated shape could provide increased rigidity tothe interior of a specialized feature where the binding structure is ofa more rigid material than the specialized feature. Some shapes may alsoreduce twisting force (e.g., the illustrated shape, having an elongatecross-section could be utilized to resist twisting). The characteristicsof the interactions between the materials of the binding structure andthe specialized feature as well as the shapes of the attachment surfacesof these items can be virtually modeled in some embodiments, forexample, using a computing device system, as illustrated in FIG. 6, todetermine a desirable combination to the used to treat a specificpatient's one or more issues.

Through use of the treatment plan and/or virtual modeling, a dentalappliance can be made, for example, by thermal-forming a sheet ofplastic over a physical dental mold. The physical dental mold, forinstance, can represent an incremental position to which a patient'steeth are to be moved.

The physical dental mold can be manufactured, for example, bydownloading a computer-aided design (CAD) virtual dental model to arapid prototyping process, such as, for example, a computer-aidedmanufacturing (CAM) milling, stereolithography, and/or photolithographyprocess. In some implementations, the virtual dental mold can behollowed out or “shelled” before sent for manufacturing to, for example,save on material cost, among other benefits.

The dental mold (e.g., set of molded teeth and/or jaw) can be createdfrom a virtual model of a number of teeth and/or jaw of a patient. Avirtual model, for example, can include an initial virtual dental modeland/or intermediate virtual dental model (wherein the teeth of thepatient have been moved with respect to their actual physical position).A dental mold can be formed in accordance with a unique treatment filethat, for example, identifies a patient, a stage of a treatment plan,the virtual model of the number of teeth and/or jaw, and/or whether thedental mold is of the upper and/or lower dental arch.

In some computing device system embodiments, a treatment file can beaccessed by a rapid prototyping apparatus machine, such as a SLA or 3Dprinting machine, to form and/or create the dental mold. As discussedabove, the result of the dental mold can include a set of molded teeth.

The set of molded teeth can include at least a replica of the number ofteeth of the patient. The dental mold can be used to make a dentalappliance, for example, by creating a negative impression of the dentalmold using polymeric sheets of material and vacuum forming the sheetsover the dental mold, as discussed above.

For instance, a dental appliance can be formed by layering athermoformable sheet of material and/or multiple sheets of one or morematerials over the dental mold. The materials can include a polymericmaterial, for instance.

Generally, the dental appliance is produced and/or formed by heating thepolymeric thermoformable sheet and vacuum or pressure forming the sheetover the dental mold (e.g., a number of molded teeth). The shape of thesheet of material can change thickness on some portions of the sheet asit conforms to the mold shape. A dental appliance can, for example,include a negative impression of the dental mold.

The appliance and/or parts thereof may be transparent, semi-transparent,or opaque in such a way as to emulate a natural tooth shade. However,embodiments in accordance with present disclosure are not so limited.For example, embodiments in accordance with the present disclosure caninclude forming a dental appliance utilizing a variety of techniques,such as SLA or 3D printing, among other techniques.

FIG. 6 illustrates a computing device that can be utilized according toone or more embodiments of the present disclosure. For instance, acomputing device 632 can have a number of components coupled thereto.The computing device 632 can include a processor 634 and a memory 636.The memory 636 can have various types of information including data 638and executable instructions 640, as discussed herein.

The processor 634 can execute instructions 640 that are stored on aninternal or external non-transitory computer device readable medium(CRM). A non-transitory CRM, as used herein, can include volatile and/ornon-volatile memory. Volatile memory can include memory that dependsupon power to store information, such as various types of dynamic randomaccess memory (DRAM), among others. Non-volatile memory can includememory that does not depend upon power to store information.

Memory 636 and/or the processor 634 may be located on the computingdevice 632 or off of the computing device 632, in some embodiments. Assuch, as illustrated in the embodiment of FIG. 6, the computing device632 can include a network interface 642. Such an interface 642 can allowfor processing on another networked computing device, can be used toobtain information about the patient, and/or can be used to obtain dataand/or executable instructions for use with various embodiments providedherein.

As illustrated in the embodiment of FIG. 6, the computing device 632 caninclude one or more input and/or output interfaces 644. Such interfaces644 can be used to connect the computing device 632 with one or moreinput and/or output devices 646, 648, 650, 652, 654.

For example, in the embodiment illustrated in FIG. 6, the input and/oroutput devices can include a scanning device 646, a camera dock 648, aninput device 650 (e.g., a mouse, a keyboard, etc.), a display device 652(e.g., a monitor), a printer 654, and/or one or more other inputdevices. The input/output interfaces 644 can receive executableinstructions and/or data, storable in the data storage device (e.g.,memory), representing a virtual dental model of a patient's dentition.

In some embodiments, the scanning device 646 can be configured to scanone or more physical dental molds of a patient's dentition. In one ormore embodiments, the scanning device 646 can be configured to scan thepatient's dentition and/or dental appliance directly. The scanningdevice 646 can be configured to input data into the computing device632.

In some embodiments, the camera dock 648 can receive an input from animaging device (e.g., a 2D or 3D imaging device) such as a digitalcamera, a printed photograph scanner, and/or other suitable imagingdevice. The input from the imaging device can, for example, be stored inmemory 636.

The processor 634 can execute instructions to provide a visualindication of a treatment plan, a dental appliance, and/or arepositioning jaw element on the display 652. The computing device 632can be configured to allow a treatment professional or other user toinput treatment goals. Input received can be sent to the processor 634as data 638 and/or can be stored in memory 636.

Such connectivity can allow for the input and/or output of data and/orinstructions among other types of information. Some embodiments may bedistributed among various computing devices within one or more networks,and such systems as illustrated in FIG. 6 can be beneficial in allowingfor the capture, calculation, and/or analysis of information discussedherein.

The processor 634, in association with the data storage device (e.g.,memory 636), can be associated with the data 638. The processor 634, inassociation with the memory 636, can store and/or utilize data 638and/or execute instructions 640 for placing binding structures and/orvirtual specialized features on a shell of a virtual model of a dentalappliance. Such data can include the virtual dental model.

The virtual model of the dental appliance with the one or more bindingstructures and/or virtual specialized features can be used to create aphysical dental appliance, for instance, as discussed further herein.The processor 634 coupled to the memory 636 can, for example, includeinstructions to cause the computing device 632 to perform a methodincluding, for example, providing a virtual model of a dental appliancehaving a shell configured to reposition a number of teeth of a patient.

In some embodiments, the processor 634 coupled to the memory 636 cancause the computing device 632 to perform the method comprisingidentifying a misaligned jaw of a patient from a virtual image of thepatient's jaw. The identification can include, for instance, determininga degree of the patient's jaw alignment utilizing the virtual image ofthe patient's jaw.

For example, identifying a misaligned jaw of the patient can includeidentifying a plurality of jaw placements of the virtual model of thejaw between stages of the treatment plan. Each of the plurality of jawplacements can be identified in a range of stages (e.g., can beassociated with). A stage can include, for example, a predeterminedperiod of time of the treatment plan (e.g., 2 weeks). A range of stagesmay be helpful (e.g., required) to reposition the jaws according to atreatment time used (e.g., needed) to re-posture the mandible.

For instance, a first jaw placement can be associated with a first rangeof stages (e.g., a first stage to a third stage) of the treatment planand a second jaw placement can be associated with a second range ofstages (e.g., a fourth stage to a fifth stage). A jaw placement, as usedherein, can include a relation of the upper jaw and the lower jaw.

As an example, a 4 mm jaw reposition can be accomplished in a single jawmovement across twelve stages of a treatment plan (e.g., six months).Dental appliances associated with the twelve stages can include the samespecialized features (e.g., repositioning jaw elements) designed to movethe jaw toward the 4 mm corrected jaw position. However, as furtherdiscussed herein, the position and/or orientation of the repositioningjaw elements between stages can be adjusted based on differences intooth positions and/or jaw relation of the patient.

By contrast, a 6 mm jaw reposition can be accomplished in two 3 mm jawmovements across sixteen stages of a treatment plan (e.g., eightmonths). Dental appliances associated with the first through eightstages of the sixteen stages can include a first set of repositioningjaw elements designed to move the jaw toward a 3 mm corrected jawposition. Dental appliances associated with the ninth through sixteenthstage of the sixteen stages can include a second set of repositioningjaw elements designed to move the jaw from the 3 mm corrected jawposition toward the 6 mm corrected jaw position (e.g., 3 mm additionaljaw movement).

In some embodiments, the processor 634 coupled to the memory 636 cancause the computing device 632 to perform the method comprisingproviding a treatment plan for the patient. The treatment plan caninclude a virtual model of a dental appliance having a first shell and asecond shell configured to reposition at least one tooth of the patient.

The at least one tooth can, for instance, include a tooth on a lower jawand/or a tooth on an upper jaw of the patient. Further, the virtualmodel of the dental appliance can include repositioning jaw elements onthe first shell and the second shell configured to move a position ofthe misaligned jaw of the patient (e.g., to move sagittally a positionof the misaligned jaw of the patient).

In various embodiments, the processor 634 coupled to the memory 636 cancause the computing device 632 to perform the method comprisingvirtually testing the jaw movement to occur by the patient wearing thedental appliance. The virtual testing can include testing jaw movement,in addition to movement of teeth, in a number of embodiments.

The virtual binding structures and/or virtual specialized features canbe adjusted based on the virtual testing of the jaw movement. Forinstance, the virtual binding structures and/or virtual specializedfeatures can be adjusted to reach an intended jaw position and/or afinal jaw position in a treatment plan. The virtual testing and/oradjustment, in some embodiments, can be across a number of stages of atreatment plan.

For example, for each stage of a treatment plan, the instructions can beexecuted to model forces applied to a virtual model of the jaw by anappliance corresponding to that stage (to simulate actual forces to beapplied to a user's physical jaw by a physical appliance). Those forcescan include forces applied to the virtual model of the jaw by thevirtual binding structures and/or virtual specialized features, byvirtue of the appliance being slightly out of alignment with a currentconfiguration of the virtual model of the teeth and/or include forcesapplied to the aligner by the user (e.g., when the user wears thephysical dental appliance).

Positioning and/or adjustment of positioning of virtual bindingstructures and/or virtual specialized features on a virtual model of ajaw can be automatic (e.g., by operation of software based on forcemodeling for a particular stage of treatment), manual (e.g., byoperation of an operator interacting with the virtual model via aninterface with a computing device), or a combination thereof. Likewise,the shape, size, orientation (e.g., various angles with respect toreferences), and/or attachment location (on the virtual teeth) of thevirtual binding structures and/or virtual specialized features can beautomatically set by the software, by manual operation (e.g., anoperator can specify the necessary criteria of the virtual bindingstructures and/or virtual specialized features and/or modify defaultcriteria provided by the software), or a combination thereof.

An automatic positioning of virtual binding structures and/or virtualspecialized features on the virtual model of the jaw can, for example,occur in response to identifying the plurality of jaw placements of thevirtual model of the jaw between stages of the treatment plan, aspreviously discussed. The position may be guided in part based on aposturing of the patient's jaw in a simulated advanced position, wherebythe postured position is captured and/or an input by means of a biteregistration that can be physical (e.g., wax or silicon bite) or digital(e.g., intraoral bite scan). Further, in some embodiments, the simulatedadvanced position may be based on photographs of the patient when thepatient's jaw is in the advanced position. At least one of the pluralityof jaw placements can be identified as a misaligned jaw, wherein the jawplacement is associated with a range of stages of the treatment plan.

A virtual model of a dental appliance having a first shell and a secondshell can be provided for at least one stage of the range of stages withthe identified misaligned jaw. Although embodiments are not so limitedand embodiments in accordance with the present disclosure can includeproviding a treatment plan that includes virtual models of dentalappliances (e.g., shells) for each stage of the treatment plan.

Virtual repositioning jaw elements can be positioned on the virtualteeth and/or virtual shells at the stage. For example, virtual bindingstructures and/or virtual specialized features can be positioned onshells of a first and a last stage of the range of stages with anidentified misaligned jaw. The position at the first and the last stageof the range of stages can include an estimated initial bindingstructure and/or virtual specialized feature position and orientation.

The positioned binding structures and/or virtual specialized featurescan be refined at intermediate stages of the range of stages (e.g.,between the first and the last stage of the range of stages). Forexample, the position at the first and the last stage of the range ofstages can be interpolated with a refined position and orientation atthe intermediate stages.

The positions at the first stage, last stage, and/or intermediate stagescan be adjusted (to a refined position and orientation) to comply with anumber of constraints, as discussed below. The refined position andorientation can include an optimized placement of the virtual bindingstructures and/or virtual specialized features.

That is, repositioning jaw elements for a first jaw placement that isassociated with a number of stages can be the same virtual bindingstructures and/or virtual specialized features for each stage in therange of stages and/or can include incremental adjustments betweenstages. For example, the incremental adjustments can be based ondifferences in tooth positions and/or jaw position between stages.

Each repositioning jaw element within the range of stages can have asimilar gross movement (e.g., move toward a corrected jaw position) withrefined position and/or oriented (e.g., refined alignment with archcurve, refined angle of interface, etc.) based on the tooth placementand/or jaw position in the stage. The interpolation between stages cansmooth the transition of the repositioning jaw elements between stageswithin the same range of stages.

As previously discussed, the dental appliances, in some embodiments, canreposition the teeth of the patient in parallel with jaw repositioning.In such embodiments, the stages of the treatment plan can be associatedwith tooth movement. For instance, movement of teeth of the patientacross the stages of the treatment plan can be designed prior to,consecutively with, and/or subsequently to the jaw repositioningplanning.

For example, movement of teeth of the patient toward a target positioncan be planned across a plurality of stages of the treatment plan. Priorto, consecutively with, and/or subsequently to planning the movement ofteeth, the jaw repositioning can be planned. As previously discussed, amisaligned jaw of a patient associated with a range of stages of thetreatment plan can be identified.

In some embodiments, during designing of the binding structures and/orspecialized features, the movement of teeth can be revised based onand/or to allow for movement of the jaw. For example, the position ofthe patient's teeth can be revised to support the corrected jaw positionand/or to allow for movement to the corrected jaw position. Thereby, therepositioning of the teeth can be planned in parallel with jawrepositioning planning.

As an example, the range of stages may be helpful because certaininterferences between the upper jaw and the lower jaw may first beeliminated (e.g., such as movement of one or more teeth) before a moreanterior position of the jaw of the patient is attained withoutsignificantly opening the bite.

The virtual dental appliance (e.g., virtual shells with the virtualbinding structures and/or specialized features) can be designed using anumber of constraints. A constraint, as used herein, can include aphysical limit or restriction of the physical dental appliance tosatisfy.

For example, the number of constraints can include physical limitationsor restrictions of a placement and/or an orientation of the bindingstructures and/or specialized features in relation to a current tootharrangement (e.g., surfaces of particular teeth, position of particularteeth, and/or the arch curve), a current jaw position, and/or apredicted corrected jaw position of the patient. A current tootharrangement and/or current jaw position, as used herein, can include atooth arrangement and/or jaw position of the patient at a particularstage of the treatment plan that the binding structures and/orspecialized features are designed for.

The tooth arrangement and/or jaw position of the patient can, forexample, change from one stage to another. Binding structures and/orspecialized features can be positioned and/or oriented for a particularstage of a treatment plan based on the tooth arrangement and/or jawposition of the patient at the particular stage. The binding structuresand/or specialized features can be the same for a range of stages of thetreatment plan to accomplish a particular jaw movement. However, theposition and/or orientation of the binding structures and/or specializedfeatures can be adjusted (e.g., are different) between the stages of therange.

The constraints can be used to optimize placement of the virtual bindingstructures and/or specialized features. For instance, the constraintscan each be satisfied, and/or satisfied to the greatest extent possible,to satisfy the greatest subset of the constraints.

For example, the virtual dental appliance can be designed by inputting acorrected jaw position of the patient and outputting binding structuresand/or specialized features that can result in and/or move the jawtoward the corrected jaw position. A corrected jaw position can includea corrected relation of the upper jaw and the lower jaw as compared tothe current jaw position of the patient, as previously discussed.

In some embodiments, the corrected jaw position can include an ideal jawposition. An ideal jaw position can include an optimal relation of theupper lower and lower jaw. The corrected jaw position can, for instance,be predicted (e.g., calculated) using patient data. For instance, thepatient data can include articulation information and/or tooth data ofthe patient.

An occlusal plane, as used herein, is a direction that is determinedbased on the bite surface of a patient. As previously discussed, anocclusal plane is parallel to the bite surface of the teeth. An occlusalplane normal is perpendicular to the occlusal plane (e.g., bite surface)of the teeth of the patient, for example.

A specific bite configuration, as used herein, can include one or morespecific contacts between opposing teeth that are identified (e.g. aspecific desired cusp-tip to fossa relationship or incisal edge toopposing fossae contact area). For instance, with a specific biteconfiguration the jaws are separated a specified amount in order tointegrate the desired dental appliance features. In FIGS. 7 and 8, twoexamples of methods according to embodiments of the present disclosureare provided.

FIG. 7 illustrates a method according to one or more embodiments of thepresent disclosure. In such an embodiment, a processor (e.g., 634)coupled to memory (e.g., 636) can cause a computing device (e.g., 632)to create a treatment plan based on a virtual model of a jaw of apatient, wherein the treatment plan includes use of a dental appliancecomprising a shell having a first surface that defines a plurality ofcavities shaped to receive a plurality of teeth of the patient, at block760.

The example instructions can also cause a computing device to modify thevirtual model of the jaw in a first configuration to include a virtualbinding structure on a second surface opposite the first surface of thedental appliance wherein the binding structure is shaped to receive aspecialized feature from a set of features that provide one or moreforce characteristics to the jaw, at block 762, and select a particularspecialized feature as an attachment to the dental appliance, at block764. The virtual model of the jaw can then be adjusted from a firstconfiguration to a second configuration, according to the treatmentplan, based at least in part on a modeled force provided by thecombination of the virtual binding structure and the particularspecialized feature, as illustrated at block 766.

In some embodiments, a processor coupled to memory can cause a computingdevice to modify the virtual model of the jaw to include the virtualbinding structure such that application of a force via a physicalselected specialized feature to a physical binding structure of a dentalappliance is formed based on the modified virtual model of the jaw whichcauses a movement of the patient's jaw according to the treatment plan.Embodiments can also include instructions to modify the virtual model ofthe jaw to include the virtual binding structure such that applicationof a force via a physical selected specialized feature to a physicalbinding structure of a physical dental appliance formed based on themodified virtual model of the jaw which causes a movement of at leastone of the plurality of teeth of the patient according to the treatmentplan. In this manner, the virtual model can model potential physicaloutcomes without having to create actual devices and test them on actualpatients.

In various embodiments, the computing device can include instructions tomodify the virtual model of the jaw in the second configuration toinclude a different virtual binding structure that is shaped to receivethe selected specialized feature and further adjust the virtual model ofthe jaw from the second configuration to a third configuration,according to the treatment plan, based at least in part on a modeledforce applied to the different virtual binding structure. In thismanner, different binding structures can be tested virtually withdifferent specialized features.

In some embodiments, the computing device can include instructions tomodify the virtual model of the jaw in the second configuration toinclude a different specialized feature that is selected and that isshaped to be received on the virtual binding structure and furtheradjust the virtual model of the jaw from the second configuration to athird configuration, according to the treatment plan, based at least inpart on a modeled force applied to the different selected specializedfeature. Such embodiments can allow for force modeling with differentspecialized features to determine which feature may be the mostappropriate feature to address a patient's one or more issues.

In various embodiments, creating a treatment plan can further includeproviding a virtual model of a plurality of virtual dental appliances,including the virtual dental appliance and wherein at least one of theother plurality of virtual dental appliances contains a differentvirtual binding structure or a different selected specialized feature.Accordingly, the treatment plan can utilize different specializedfeatures during different stages of treatment. This can be accomplishedon different appliances, or if the specialized features are removable,on the same appliance.

In some embodiments, the virtual image of the jaw of patient can includea virtual image of the mandible, its related soft and hard tissue, anumber of teeth the patient's lower dentition, the maxilla, its relatedsoft and hard tissues, and/or a number of teeth of the patient's lowerdentition. The degree of the patient's jaw alignment can include, forinstance, a path of articulation or jaw opening and closing. It may alsoinclude a repositioned location such as a protruded position, or acombination of semi-articulation and protrusion, for example.

Some embodiments can include providing a virtual model of a dentalappliance having a shell configured to reposition a number of teeth of apatient. The virtual model of the dental appliance can, for instance, becreated from a virtual model of the jaw of the patient and/or from aphysical mold of the jaw of the patient. A virtual repositioning jawelement can, for example, be positioned on a binding structure of theshell of the virtual model of the dental appliance wherein an attachmentsurface of the binding structure can be parallel to a occlusal plane ofthe patient and when a repositioning jaw element is positioned thereoncan include a portion that extends from a surface of the shell of thevirtual model of the dental appliance.

In various embodiments, the computing device can include instructions toselect an attachment type for attachment of the particular specializedfeature to the dental appliance and adjust the virtual model of the jawfrom a first configuration to a second configuration, according to thetreatment plan, based at least in part on a modeled force provided bythe combination of the virtual binding structure, the attachment type,and the particular specialized feature. In this manner, the selection ofthe attachment type can be tested to determine the most suitableattachment type for use with a specific patient.

FIG. 8 illustrates a method according to one or more embodiments of thepresent disclosure. In such an embodiment, a processor (e.g., 634)coupled to memory (e.g., 636) can cause a computing device (e.g., 632)to perform a method including, creating a treatment plan based on avirtual model of a jaw of a patient, wherein the treatment plan includesuse of a specialized feature, at block 870. The method also includesmodeling a virtual dental appliance based on the treatment plan, whereinthe virtual dental appliance includes a first shell and a second shelland wherein at least one of the first shell and the second shell areconfigured to reposition a tooth of the patient, at block 872, andpositioning a virtual binding structure on the virtual dental appliancespecific to the patient such that the specialized feature can beattached to a corresponding physical binding structure on a physicaldental appliance fabricated according to the virtual dental appliance,at block 874.

Such methods can also include wherein the virtual dental appliance isassociated with a first stage of a plurality of stages of the treatmentplan and creating the treatment plan includes providing virtual modelsof dental appliances for each stage of the treatment plan, wherein aposition of the binding structure is adjusted for each stage of thetreatment plan.

In some embodiments, the virtual binding structure includes a firstvirtual binding structure that extends from a surface of the first shelland wherein the virtual dental appliance includes a second virtualbinding structure that extends from a surface of the second shell. Inthis manner, the treatment plan can include first and second shells eachhaving a binding structure thereon and, as discussed herein, a same ordifferent type of specialized feature and/or attachment material can beutilized to customize each of the shells to a particular patient'sneeds.

For example, in some embodiments, the method can include adjusting theposition of the virtual binding structure to comply with a number ofconstraints, for example, wherein the number of constraints includealigning an interface of the specialized feature and another specializedfeature with an occlusal plane normal of the patient. In variousembodiments, the attachment of the specialized feature to the virtualbinding structure can be displayed for viewing by the patient and/ortreatment professional.

In some embodiments, creating the treatment plan can include identifyinga misalignment in a jaw of the patient and selecting the specializedfeature from a plurality of specialized features based on a treatment ofthe misaligned jaw. In this manner, a computing device via a processorcan, for example, analyze data to identify whether a misalignment of ajaw is present in a patient and can select an appropriate specializedfeature based on the analyzed data.

The positioning of the virtual repositioning jaw element and/or thedesign of the virtual specialized feature can be based on and/orincluded in a treatment plan. For instance, the treatment plan caninclude a desired, ideal, and/or final jaw positions and/or suggestedpositions for one or more specialized features (e.g., repositioning jawelements) on a binding structure. The treatment professional can thenreview and revise these positions such that the virtual model of thedental appliance has a suggested or revised position of the specializedfeature which can be used to create a physical dental appliance, forinstance, as discussed further herein.

As discussed above, the virtual model of the dental appliance, includingthe virtual repositioning jaw element, can be used to determine atreatment plan for the patient and/or to form a physical dentalappliance and/or physical repositioning jaw element (e.g., as discussedfurther herein).

In some embodiments, the virtual model can include the patient's upperjaw and/or lower jaw. A virtual model of one or more dental appliances(e.g., an appliance for the upper dentition and an appliance for thelower dentition which may also be connected together) each having ashell configured to reposition a number of teeth of the patient can beprovided. The virtual model of the dental appliance can include avirtual model of a dental appliance configured to reposition the numberof teeth of the patient.

Specialized features can be positioned on binding structures provided onocclusal, buccal, and/or lingual surfaces of a dental appliance to beplaced over the patient's teeth. For instance, a virtual specializedfeature can be positioned on the shell of the virtual model of thedental appliance parallel to an occlusal plane of the patient. Anocclusal plane, as used herein, can include a surface from the incisaledges of the incisors and the tips of the occluding surfaces of theposterior teeth that is a mean of the curvature of the surface.

An appliance can, for example, be fabricated from a polymeric shell,and/or formed from other material, having a number of cavities shaped(e.g. tooth apertures) to receive and apply force to reposition one ormore teeth from one geometric tooth arrangement to one or moresuccessive tooth arrangements. There may be several appliances that maybe needed to move the teeth from the beginning of a dental treatmentplan to the end of the plan.

The shell may be designed to fit over a number of, or in many instancesall, teeth present in the upper and/or lower jaw. For example, a shellcan have a cavity that includes a number of tooth apertures forplacement of teeth therein.

Each tooth aperture can include an interior surface (e.g., directlyadjacent to the surfaces of the teeth placed therein) and an exteriorsurface. The interior surface is configured to receive and reposition anumber of teeth of the patient, for example. In some situations, such asanterior crossbite and deep bite can be treated using the specializedfeatures in the form of repositioning jaw elements to allow forindividual movement of teeth while the jaws are repositioned into a newrelative relationship.

Patients with crossbites and/or deep bites can have anterior incisors inthe upper jaw and/or the lower jaw that are difficult to move into thedesired location because teeth in the opposing jaw are a physicalobstruction and therefore can prevent the desired movement from takingplace, in some instances. The repositioning jaw elements (e.g., a twinblock design wherein a first block is mounted to a binding structure ofa upper shell (a first shell) and a second block is mounted to a bindingstructure of a lower shell (a second shell)) can provide separation ofthe upper jaw from the lower jaw (e.g., disclusion) by separating anocclusal surface of the first shell from an occlusal surface of thesecond shell.

The repositioning jaw elements can be positioned near posterior teeth,for instance, to allow for an anterior portion of the bite of thepatient to open enough (e.g., disengage the occlusal interferences thatmay normally take place) to allow for easier treatment of the crossbiteand/or deep bite. For instance, the separation of occlusal surfaces canbe caused by preventing the cusp of the molars from sliding back intothe fossae on the opposing molars. In such situations, the upper jaw andthe lower jaw are held apart and avoid interfering with the prescribedtreatment, for example.

The removable dental appliance can be configured to reposition a numberof teeth of the patient's upper dentition and a number of teeth of thepatient's lower dentition concurrently with repositioning of thepatient's jaw. The simultaneous treatment of misalignment of a patient'sjaw (e.g., Class II correction) in conjunction with teeth alignmentissues (e.g., rotation, tipping, etc.) can shorten treatments timescompared to sequential treatment protocols that first treat themisalignment of a patient's jaw before treating the misalignment of thepatient's teeth. To help accomplish this objective, specializedfeatures, in accordance with a number of embodiments, do not interferewith the engagement of the shell with the teeth contained therein.

The simultaneous treatment of misalignment of a patient's jawconcurrently with teeth misalignment can assist in the treatment ofrepositioning the patient's jaw. If untreated, teeth misalignment mayencourage occlusion in the original jaw position instead of the desiredjaw position (e.g., the intended or final jaw position), since theoptimal interdigitation between the arches coincides with the originaljaw position.

Realignment of the teeth so that the teeth fit together most desirablejaw position can reinforce the desired jaw position when the appliancesare removed. Repositioning of the patient's jaw can include retrainingthe muscles associated with the movement of the lower jaw.

Due to the misalignment of a patient's teeth, a lower jaw of the patientcan be incorrectly positioned in a retruded position because the teethposition with the best fit may force the jaw into a more retrudedposition than physiologically comfortable. A treatment whereby the teethfit better in an anteriorly positioned mandible can relieve the jointcompression that may take place when the mandible is retruded. The jawmuscles of the patient can be retrained to hold the lower jaw in a moreforward (and more comfortable) position.

As discussed above, in some embodiments, a specialized feature can behollow and/or can be filed with a material, such as a tooth coloredmaterial, a clear material, an acrylic, and/or a composite, among othermaterials, including materials that are printed via a three-dimensional(3D) printer or a through a stereolithography process. The extramaterial can, for instance, provide additional compressive strength ascompared to a hollow specialized feature.

In various embodiments, the specialized feature can be made of amaterial that can be modified by the treatment professional (e.g. amaterial that can be filed down when appliance is fitted to the patientby a dentist, orthodontist, or dental hygienist or assistant, or amaterial to which the treatment professional can bond a shim or someother piece, if needed).

In some embodiments, the hollow space within the specialized feature canbe used as a reservoir for the disbursement of medications or otheritems within the patient's mouth. For example, breath freshening agents,medications to aid in moving of teeth and/or improvement of thecondition of the teeth and/or gums of the patient may be providedtherein and dispensed through holes and/or passages formed in theinterior and/or exterior sides of the specialized feature.

A hollow specialized feature can increase the flexibility of the shellto which the specialized feature is attached. The increased flexibilityintroduced can lower the functionality and/or the retention of thedental appliance in a vertical or horizontal direction. For example, asa patient moves to a fully engaged jaw position and the specializedfeatures interface, the force placed on the shell can result in agingival line of the shell flaring (e.g., moving away) from the gum lineof the patient. In a number of embodiments, a number of designcharacteristics and/or elements can be used to reduce and/or eliminatethe increase in flexibility, such as grooves and curved specializedfeatures.

Additionally, in some embodiments, positioning the specialized featureson the lingual surface of the shell can, for instance, result in adental appliance that is more aesthetically pleasing to the patientbecause the specialized features are less visible to others (e.g.,decreasing the prominence of the specialized features). Alternatively orin addition, a number of specialized features can extend from a lingualsurface of the shells and a number of specialized features can extendfrom a buccal surface of the shell.

As discussed above, in some embodiments, the treatment plan can includemultiple stages. As used herein, a “first stage” does not necessarilymean the original stage of a treatment plan, but is a relative term withrespect to other stages. For example, the “first stage” may be a secondstage of a 50 stage treatment plan, while the “second stage” may be atenth stage of the 50 stage treatment plan, while the “third stage” maybe a 30th stage of the 50 stage treatment plan, and the “fourth stage”may be a 46th stage of the 50 stage treatment plan.

The treatment plan may just treat the position of the jaw or, in someembodiments, the treatment of the position of the jaws can be combinedwith the movement of one or more teeth on one or both jaws. Forinstance, the series of dental appliances can be used to incrementally(e.g., in increments of 0.1 mm) move a position of a misaligned jaw of apatient. This can be beneficial as typical current jaw alignmenttechniques move a jaw in large increments, such as 0.5 mm or greater,which may cause discomfort to the patient, among other issues.

As discussed above, each treatment stage can include a gradual movementof a lower jaw of a patient. The increments can occur based on changesin the mesial-distal length of the repositioning jaw elements (i.e.,specialized features and/or corresponding binding structures) and/orshifts in placement of the repositioning jaw elements on the shell (e.g.shift at least one repositioning jaw element in a mesial or distaldirection).

Each dental appliance in the treatment plan (e.g., at each treatmentstage) can be configured to reposition the number of teeth of thepatient's upper dentition and the number of teeth of the patient's lowerdentition and/or reposition of the patient's jaw. For instance, therepositioning of the patient's jaw can be incremental across the numberof treatment stages.

An incremental reposition of the patient's jaw can include, forinstance, gradual advancement of the lower jaw. As described herein, thegradual advancement can be achieved by shifting the placement of atleast one of the repositioning jaw elements from a first stage (e.g.,first dental appliance) to a second stage (e.g., second dentalappliance) and/or changing the mesial-distal length of at least one ofthe repositioning jaw elements from a first stage to a second stage ofthe treatment plan.

The embodiments of the present disclosure provide for utilization of oneor more binding structures on an appliance with one or more specializedfeatures to provide specialized functionality to a patient based ontheir specific needs. Although specific embodiments have beenillustrated and described herein, those of ordinary skill in the artwill appreciate that any arrangement calculated to achieve the sametechniques can be substituted for the specific embodiments shown. Thisdisclosure is intended to cover any and all adaptations or variations ofvarious embodiments of the disclosure.

It is to be understood that the above description has been made in anillustrative fashion, and not a restrictive one. Combination of theabove embodiments, and other embodiments not specifically describedherein will be apparent to those of skill in the art upon reviewing theabove description. The scope of the various embodiments of thedisclosure includes any other applications in which the above structuresand methods are used. Therefore, the scope of various embodiments of thedisclosure should be determined with reference to the appended claims,along with the full range of equivalents to which such claims areentitled.

In the foregoing Detailed Description, various features are groupedtogether in example embodiments illustrated in the figures for thepurpose of streamlining the disclosure. This method of disclosure is notto be interpreted as reflecting an intention that the embodiments of thedisclosure require more features than are expressly recited in eachclaim.

Rather, as the following claims reflect, inventive subject matter liesin less than all features of a single disclosed embodiment. Thus, thefollowing claims are hereby incorporated into the Detailed Description,with each claim standing on its own as a separate embodiment.

What is claimed is:
 1. A non-transitory computing device readable mediumstoring instructions executable by a processor to cause a computingdevice to: create a treatment plan based on a virtual model of a jaw ofa patient, wherein the treatment plan includes use of a dental appliancecomprising a shell having a first surface that defines a plurality ofcavities shaped to receive a plurality of teeth of the patient; modifythe virtual model of the shell in a first configuration to include avirtual binding structure on a second surface opposite the first surfaceof the dental appliance wherein the binding structure is shaped toreceive a specialized feature that provide one or more forcecharacteristics to the jaw; select a particular specialized feature asan attachment to the dental appliance; and adjust the virtual model ofthe jaw from a first configuration to a second configuration, accordingto the treatment plan, based at least in part on a modeled forceprovided by the combination of the virtual binding structure and theparticular specialized feature.
 2. The medium of claim 1, includinginstructions to modify the virtual model of the shell to include thevirtual binding structure such that application of a force via aphysical selected specialized feature to a physical binding structure ofa dental appliance is formed based on the modified virtual model of thejaw which causes a movement of the patient's jaw according to thetreatment plan.
 3. The medium of claim 1, including instructions tomodify the virtual model of the shell to include the virtual bindingstructure such that application of a force via a physical selectedspecialized feature to a physical binding structure of a physical dentalappliance is formed based on the modified virtual model of the shellwhich causes a movement of at least one of the plurality of teeth of thepatient according to the treatment plan.
 4. The medium of claim 1,including instructions to: modify the virtual model of the shell in thesecond configuration to include a different virtual binding structurethat is shaped to receive the selected specialized feature; and furtheradjust the virtual model of the jaw from the second configuration to athird configuration, according to the treatment plan, based at least inpart on a modeled force applied to the different virtual bindingstructure.
 5. The medium of claim 1, including instructions to: modifythe virtual model of the jaw in the second configuration to include adifferent specialized feature that is selected and that is shaped to bereceived on the virtual binding structure; and further adjust thevirtual model of the jaw from the second configuration to a thirdconfiguration, according to the treatment plan, based at least in parton a modeled force applied to the different selected specializedfeature.
 6. The medium of claim 1, wherein creating the treatment planfurther includes: providing a virtual model of a plurality of virtualdental appliances, including the virtual dental appliance; and whereinat least one of the other plurality of virtual dental appliancescontains a different virtual binding structure or a different selectedspecialized feature.
 7. The medium of claim 1, including instructionsto: select an attachment type for attachment of the particularspecialized feature to the dental appliance; and adjust the virtualmodel of the jaw from a first configuration to a second configuration,according to the treatment plan, based at least in part on a modeledforce provided by the combination of the virtual binding structure, theattachment type, and the particular specialized feature.
 8. Anon-transitory computing device readable medium storing instructionsexecutable by a processor to cause a computing device to perform amethod, comprising: creating a treatment plan based on a virtual modelof a jaw of a patient, wherein the treatment plan includes use of aspecialized feature; modeling a virtual dental appliance based on thetreatment plan, wherein the virtual dental appliance includes a firstshell and a second shell; and positioning a virtual binding structure onthe virtual dental appliance specific to the patient such that thespecialized feature can be attached to a corresponding physical bindingstructure on a physical dental appliance fabricated according to thevirtual dental appliance.
 9. The medium of claim 8, wherein the virtualdental appliance is associated with a first stage of a plurality ofstages of the treatment plan and creating the treatment plan includes:providing virtual models of dental appliances for each stage of thetreatment plan, wherein a position of the binding structure is adjustedfor each stage of the treatment plan.
 10. The medium of claim 8, whereinthe virtual binding structure includes a first virtual binding structurethat extends from a surface of the first shell and wherein the virtualdental appliance includes a second virtual binding structure thatextends from a surface of the second shell.
 11. The medium of claim 8,wherein the instructions are executable to perform the method includingdisplaying attachment of the specialized feature to the virtual bindingstructure.
 12. The medium of claim 8, wherein creating the treatmentplan includes: identifying a misalignment in a jaw of the patient; andselecting the specialized feature from a plurality of specializedfeatures based on a treatment of the misaligned jaw.
 13. A removabledental appliance, comprising: a first shell having a number of toothapertures configured to receive a number of teeth of a patient's upperjaw, the first shell including a first binding structure positionedspecific to the patient and having a platform surface having apredetermined shape to mate with an attachment surface of a firstspecialized feature that can be attached to the first binding structure.14. The appliance of claim 13, wherein the binding structure andspecialized feature are attached using a bonding material.
 15. Theappliance of claim 13, wherein the binding structure and specializedfeature are attached via a mechanical lock.
 16. The appliance of claim15, wherein the appliance includes a second shell having a number oftooth apertures configured to receive a number of teeth of a patient'slower jaw, the second shell including a second binding structurepositioned specific to the patient such that a second specializedfeature can be attached to the second binding structure, and wherein thefirst binding structure and the second binding structure includeprotruding elements to mechanically lock with intruding elements of thefirst and the second specialized features.
 17. The appliance of claim16, wherein the first and the second specialized features are formed ofa different material than at least one of the first shell, the secondshell, and the first binding structure, and second binding structure.18. The appliance of claim 17, wherein the first shell, the secondshell, and the first and the second binding structures are formed of asame polymeric material.
 19. The appliance of claim 13, wherein thefirst binding structure and the second binding structure extend from anocclusal surface of the first shell and the second shell.
 20. Theappliance of claim 13, wherein the first binding structure and thesecond binding structure include surfaces that are angled and protrudeaway from an occlusal plane of the patient.
 21. The appliance of claim13, wherein the first and the second specialized features are formed ofa same material as at least one of the first shell, the second shell,and the first binding structure, and second binding structure.
 22. Adental appliance system, comprising: a first dental appliance includinga first shell having a number of tooth apertures configured to receive anumber of teeth of a patient according to a first stage of a treatmentplan, the first shell including a first binding structure positionedspecific to a tooth arrangement of the patient associated with the firststage such that a first specialized feature can be attached to the firstbinding structure; and a second dental appliance including a secondshell having a number of tooth apertures configured to receive a numberof teeth of the patient according to a second stage of the treatmentplan, the second shell including a second binding structure positionedspecific to a tooth arrangement of the patient associated with thesecond stage such that a second specialized feature can be attached tothe second binding structure.
 23. The dental appliance system of claim22, wherein the first dental appliance is configured to reposition a jawof the patient a first incremental distance according to the first stageof the treatment plan.
 24. The dental appliance system of claim 23,wherein the first dental appliance is configured to reposition one ormore teeth of the patient a first incremental distance according to thefirst stage of the treatment plan.
 25. The dental appliance system ofclaim 23, wherein the second dental appliance is configured toreposition the jaw of the patient a second incremental distanceaccording to the second stage of the treatment plan.
 26. A removabledental appliance, comprising: a first shell having a number of toothapertures configured to receive a number of teeth of a patient's upperjaw, the first shell including a first binding structure positionedspecific to the patient and having a surface with a predetermined shapeto mate with an attachment surface of a first specialized feature thatcan be attached to the first binding structure and wherein at least oneof the first binding structure or specialized feature can be made of amaterial that can be modified by a treatment professional to create amating arrangement or to which a shim can be bonded thereto.